One-trocar-assisted pyeloplasty: An attractive alternative to open pyeloplasty

Afr J Paediatr Surg. 2015 Oct-Dec;12(4):266-9. doi: 10.4103/0189-6725.172569.

Abstract

Background: To survey the effects of one-trocar-assisted pyeloplasty (OTAP) in the treatment of ureteropelvic junction obstruction (UPJO) in kids.

Materials and methods: Forty-four children (±3.5 years) were submitted to OTAP procedure. A flank incision under the XII rib was made, the Gerota's fascia was achieved and a balloon Hasson trocar with an operative telescope inserted for retroperitoneal access. The renal pelvis and ureter were isolated and exteriorised. Forty-two patients underwent Anderson-Hynes dismembered and one Fenger pyeloplasty . One patient was converted to an open procedure. Two patients presented an aberrant crossing vessel. In all patients, a double J stent was positioned. The operative time and length of stay (LOS) were evaluated. Renal scan and ultrasound (US) were utilised to evaluate the results from 6 to 12 months.

Results: OTAP was successful in all but 1 patient. Mean operative time and LOS were 128 min and 3,5 days. We had four operative complications (9.09%). The US and a nuclear scan confirmed the resolution of the UPJO in all patients except one with the Fenger pyeloplasty who had an open Anderson-Hynes.

Conclusions: The combination of retroperitoneoscopic and open procedures for dismembered pyeloplasty offers a simple, time-saving method in a minimally invasive fashion with low morbidity for patients with UPJO.

MeSH terms

  • Child
  • Child, Preschool
  • Equipment Design
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Kidney Pelvis / surgery*
  • Male
  • Operative Time
  • Plastic Surgery Procedures / instrumentation*
  • Retroperitoneal Space / surgery
  • Surgical Instruments*
  • Time Factors
  • Treatment Outcome
  • Ureter / surgery*
  • Ureteral Obstruction / surgery*
  • Urologic Surgical Procedures / instrumentation*